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RCW 64.55 MULTI-FAMILY CERTIFICATION WORKSHEET <br />CITY OF EVERETT PERMIT SERVICES <br />3200 Cedar Street, Everelt, WA 982D7 <br />525-251-8810 - FAX 425�257-8857 - www everetnva ora <br />REHABILITATIVE CONSTRUCTION, NEW CONSTRUCTION, RECORDED COVENANT OR CONVERSION <br />CHECN <br />oNe CNp P�JflTnl- a,�r <br />eOX Property Name <br />Address <br />�,�� I �30� <br />Bwlding Number Pertnit Number <br />❑ REHABILITATIVE CONSTRUCTION equal to or less than 5% or less of current assessed <br />market improvement value of specified building' <br />'NOTE: Applicant to provide entire cost of rehabilitative construction to the buildmg enclosure for a mulUunit <br />resdential building or mixed use project per RCW 64.55A10, which may exceed the valuation for building permit. <br />ENCLOSURE REHAB COSTIfBI MULTIPLY (A1 BY 100 I IC) ASSESSED BUILOING VALUE IlDI OIVIDE f81 bv (C) _% <br />NEW CONSTRUCTION OR REHABILITATIVE CONSTRUCTION equal to more than 5% of <br />current assessed market improvement value of specified building' <br />'NOTE: Per RCW fi4.55.010, RCW 64.55A20 and RCW 64.55.060 <br />Each building enclosure design document is to be stamped and signed by a Washington State architect The <br />documents should also contain a stamped signed statement by lhe same architect lhat "the undersigned has <br />provided building enclosure documents lhat in my professional judgment are appropriate to satisfy the requirements <br />or RCW 64.55.005 through 64.55.090'. <br />Final inspection or 'CeAificate of Occupancy' cannot be issu?d by the building department prior to receipt ot a <br />signed letter from an independent inspector certifying that the building enclosure has been inspected during the <br />course of conslruction and has been constnicted in substantiai compiiance with the bwlding enclosure design <br />documents. <br />❑ � RECORDED COVENANT OF SALE from Snohomish County' <br />'NOTE Sale Prohibition Covenant per RCW 64.55A10 <br />Submll site plan with location of building, permit with description of work and certified copy o( rewrded covenanl <br />from the real property records of Snohomish County, Washington for specified building. <br />❑ I CONVERSION to condominium` <br />'NGTE: permits may be required by ihe City of Everelt per the resulls of the independent inspection report <br />Undersigned will comply with owner independenl inspeclion alternative per RCW 64.55A90 and RCW 64 34A00(2). <br />�A N (� �Ti.�� <br />�zz337z W II i3 <br />Signature of Owner or Aulhonzetl Agknt Prinled name of Owner or Aulhonzed AgeN Phone # Date <br />� <br />Aa e A�,i���s �io� Ccu� fl� S-r �� 3�m�L� q 3�z—ti <br />Pnnletl name of Business Atldress City Zip Code <br />chklst-ncw com and condo �rev 4123/OA) <br />POR OFFICE US[ OTLY <br />